Local therapy facilitators working with children with developmental delay in rural and remote areas of western New South Wales,Australia: the ‘Outback’ service delivery model

Australia's dispersed population in rural areas contributes to poor access to therapy services and the inability of the existing rural therapy workforce to meet demand. As a result, rural children with a developmental delay wait a long time for therapy. This paper describes participant perceptions of a therapy facilitation service model that has worked to improve access to therapy for children in these circumstances. The model, given the pseudonym ‘Outback’, operates in rural and remote areas of western New South Wales. ‘Outback’ employs local people to work under the guidance of therapists based in larger centres to provide preschool children with developmental delays with access to therapy interventions they might not otherwise receive. A two‐stage case study design involving focus groups and interviews with the director, four therapy facilitators, nine therapists, and seven carers was used. Three themes were identified as central to the service model: 1) being part of the local community; 2) developing therapy facilitator knowledge and skills; 3) improving access to therapy intervention for children in rural and remote areas. The ‘Outback’ model demonstrates that appropriately supported, local therapy facilitators provide a flexible workforce adjunct that expands the reach of therapists into rural and remote communities and enhances service access for children and their families.     

A New Ridge Regression Causality Test in the Presence of Multicollinearity

The VAR lag structure applied for the traditional Granger causality (GC) test is always severely affected by multicollinearity due to autocorrelation among the lags. Therefore, as a remedy to this problem we introduce a new Ridge Regression Granger Causality (RRGC) test, which is compared to the GC test by means of Monte Carlo simulations. Based on the simulation study we conclude that the traditional OLS version of the GC test over-rejects the true null hypothesis when there are relatively high (but empirically normal) levels of multicollinearity, while the new RRGC test will remedy or substantially decrease this problem.     

Granger Causality Test in the Presence of Spillover Effects

In this article, we investigate the effect of spillover (i.e., causality in variance) on the reliability of Granger causality test based on ordinary least square estimates. We studied eight different versions of the test both, with and without Whites heteroskedasticity consistent covariance matrix (HCCME). The properties of the tests are investigated by means of a Monte Carlo experiment where 21 different data generating processes (DGP) are used and a number of factors that might affect the test are varied. The result shows that the best choice to test for Granger causality under the presence of spillover is the Lagrange Multiplier test with HCCME.     

A Simulation Study of Some Ridge Regression Estimators under Different Distributional Assumptions

Based on the work of Khalaf and Shukur (2005 Khalaf , G. , Shukur , G. ( 2005 ). Choosing ridge parameters for regression problems . Communications in Statistics – Theory and Methods 34 : 1177 – 1182 .[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]), Alkhamisi et al. (2006 Alkhamisi , M. , Khalaf , G. , Shukur , G. ( 2006 ). Some modifications for choosing ridge parameters . Communications in Statistics – Theory and Methods 35 : 2005 – 2020 .[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]), and Muniz et al. (2010 Muniz , G. , Kibria , B. M. G. , Shukur , G. ( 2010 ). On developing ridge regression parameters: a graphical Investigation. Submitted for Publication . [Google Scholar]), this article considers several estimators for estimating the ridge parameter k. This article differs from aforementioned articles in three ways: (1) Data are generated from Normal, Student's t, and F distributions with appropriate degrees of freedom; (2) The number of regressors considered are from 4–12 instead of 2–4, which are the usual practice; (3) Both mean square error (MSE) and prediction sum of square (PRESS) are considered as the performance criterion. A simulation study has been conducted to compare the performance of the estimators. Based on the simulation study we found that, increasing the correlation between the independent variables has negative effect on the MSE and PRESS. However, increasing the number of regressors has positive effect on MSE and PRESS. When the sample size increases the MSE decreases even when the correlation between the independent variables is large. It is interesting to note that the dominance pictures of the estimators are remained the same under both the MSE and PRESS criterion. However, the performance of the estimators depends on the choice of the assumption of the error distribution of the regression model.     

Performance of Some Ridge Parameters for Probit Regression: With Application to Swedish Job Search Data

In ridge regression, the estimation of the ridge parameter is an important issue. This article generalizes some methods for estimating the ridge parameter for probit ridge regression (PRR) model based on the work of Kibria et al. (2011 Kibria, B. M. G., Månsson, K. and Shukur, G. 2011. Performance of some logistic ridge regression parameters. Computational Economics, DOI: 10.1007/s10614-011-9275-x [Google Scholar]). The performance of these new estimators is judged by calculating the mean squared error (MSE) using Monte Carlo simulations. In the design of the experiment, we chose to vary the sample size and the number of regressors. Furthermore, we generate explanatory variables that are linear combinations of other regressors, which is a common situation in economics. In an empirical application regarding Swedish job search data, we also illustrate the benefits of the new method.     

Challenges of Dealing with Financial Concerns during Life-Threatening Illness: Perspectives of Health Care Practitioners

ABSTRACT

The costs of serious medical illness and end of life care are often a heavy burden for patients and families (Collins, Stepanczuk, Williams, & Rich, 2016 Collins, A., Stepanczuk, C., Williams, N., & Rich, E. (2016). Supporting better patient decisions at the point of care: What payers and delivery systems can do (Mathematica Policy Research Issue Brief). Retrieved from http://econpapers.repec.org/paper/mprmprres/6c6a86e28d7149c993713352eeceaa18.htm [Google Scholar]; Kim, 2007 Kim, P. (2007). Cost of cancer care: The patient perspective. Journal of Clinical Oncology, 25(2), 228–232. doi:10.1200/JCO.2006.07.9111[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; May et al., 2014 May, C. R., Eton, D. T., Boehmer, K., Gallacher, K., Hunt, K., MacDonald, S.,?… &?Rogers, A. E. (2014). Rethinking the patient: Using burden of treatment theory to understand the changing dynamics of illness. BMC health services research, 14(1), 1–11. doi:10.1186/1472-6963-14-281[Crossref], [PubMed] , [Google Scholar]; Zarit, 2004 Zarit, S. H. (2004). Family care and burden at the end of life. Canadian Medical Association Journal, 170(12), 1811–1812. doi:10.1503/cmaj.1040196[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Twenty-six practitioners, including social workers, managers/administrators, supervisors, and case managers from five health care settings, participated in qualitative semistructured interviews about financial challenges patients encountered. Seven practitioners took part in a focus group. Practitioners were recruited from hospice (n?=?5), long-term care (n?=?5), intensive care (n?=?5), dialysis (n?=?6), and oncology (n?=?5). Interview and focus group questions focused on financial challenges patients encountered when facing life-threatening illness. Interview data were transcribed and thematically coded and trustworthiness of data was established with peer debriefing, member checking, and agreement on themes among the authors. Practitioners described interacting micro, meso, and macroinfluences on the financial well-being and challenges patients encountered. Microlevel influences involved patient characteristics, such as their demographic profile and/or health status that set them up for financial aptitude or challenges. Macrolevel influences involved the larger health care/safety net system, which provided valuable resources for some patients but not others. Practitioners also discussed the mesolevel of influence, the local setting where they worked to match available resources with patients’ individual needs given the constraints emerging from the micro and macrolevels. Practitioners described how they navigated the interplay of these three areas to meet patients’ needs and cope with financial challenges. Implications for practice point to directly addressing the kind of financial concerns that patients and families facing financial burden from serious medical illness have, and identifying ways to bridge knowledge and resource access gaps at the individual, organizational, and societal levels.     

The Riddle of Schizophrenia

This paper discusses the author's emotions and reactions, in her working experience with people diagnosed as schizophrenic.     

The influence of negative medical diagnoses and verbal and nonverbal support activation strategies on the interactive coping process

Sensitive Interaction Systems Theory suggests that complex problems, including adverse medical diagnoses, can create tension in the social support process. In this experiment one member of a romantic couple received medical feedback that either threatened gender roles or was irrelevant. The couple's interaction was covertly recorded for the support activation behaviors displayed by the support seeker and for the interactive coping behaviors offered by the help giver. Both type of support activation and type of problem affected the use of support behavior.Nonverbal support activation behaviors promoted helpers' use ofavoidance interactive coping behaviors, whereasverbal activation behaviors promotedapproach interactive coping behaviors, suggesting a tit-for-tat dynamic. The gender-role relevance of the medical diagnosis also influenced helpers' use of approach behaviors, although not the support seekers' need for support or efforts to elicit support.     

Constructing motherhood on the night shift: “Working mothers” as “stay-at-home moms”

Based on in-depth interviews with hospital nurses, this article examines the way in which employed women with children use the night shift to support a construction of motherhood which closely resembles that of mothers who are not in the labor force. Interview data reveal that a salient function of night shift work is the reconciliation of some of the structural and conceptual incompatibilities of being “working mothers.” Night-shift nurses construct themselves as “stay-at-home moms” by limiting the public visibility of their labor force participation, by involving their children and themselves in symbolically-invested activities, and by positioning themselves in the culturally-appropriate place and time: at home, during the day. All of these strategies work to highlight their visibility as mothers. An earlier version of this article was presented at the American Sociological Association Annual Meeting, August 13–17, 1993, Miami Beach, Florida. Funds for this research were provided in part by the University of California and by the National Institute of Child Health and Human Development.     

Speaking Personally

In this recent address to the Victorian Association of Family Therapists, the author discusses some of the changes in her personal and family life, since learning that she had an inoperable, malignant brain tumour. These changes have helped her clarify key aspects of her work with families and colleagues.